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23 yr old male/L5-S1 PLIF with hardware/5 months post-op/progressively worsening-expanding symptoms

AnonymousUserAAnonymousUser Posts: 49,899
edited 06/11/2012 - 8:23 AM in Pain Management
Hello, I am new to this website and this is my first forum post. My knowledge of my condition and options are small but growing. Everyone please consider that I know nothing, all thoughts are welcome. I want to learn everything I can.

I am a 23 year old male who has suffered 3 compression fractures from 2 incidents. The first was a snowmobile accident at age 17 where I suffered a compression fracture which caused a disk to bulge, both of which in my lumbar region. After a few weeks of lessening pain(the only symptom) I believed I had made a full recovery and only suffered moderate pain after strenuous use of the lower back. I was also diagnosed with Degenerative Disk Disease and Spondylolisthesis. Though, to this day, I sometimes get the Spon(etc) conditions mixed up so I could be mistaken about which condition I actually have.

The second incident caused 2 more compression fractures in my lumbar region, suffered while serving in the Marine Corps. I believe due to my spine being already weakened and unable to properly absorb the impact. From that point on the pain started bad and got worse... I was subsequently discharged.

After exploring all alternatives including physical therapy, steroid injections into my spine(which made the pain worse for a few days before going back to the way it was before), OTC pain medications including ibuprofen and acetaminophen, prescription medications such as naproxen, gabapentin, flexeril, and others which I forget... Eventually I decided to have a Spinal Fusion.

19 May 2008 was the surgery date. Due to the medications I was on such as Morphine and Diazepam my memory is a little foggy but one thing I remember very clearly is that during the 3-4 days in the hospital it was impossible to get my pain under control. I have fractured the 2nd, 3rd, and 4th metatarsals in my left foot to the point of requiring reconstructive surgery and honestly that pain only begins to describe the agony I was in during the first 2-3 weeks post-op. After that, it showed some improvement for about a month before coming to rest at where I am at currently.

After increasing my medication from 10/325 mg's hydrocodone/apap 4xdaily to 60-80 mg's daily(depending on pain), my surgeon prescribed Oxycontin 10 mg's 2xdaily along with 10 mg's hydrocodone/apap 4xdaily. After realizing that the Oxycontin was not lasting 12 hours, only 6-8, and pain showing no improvement along with worsening lower limb symptoms such as pain, tingling, numbness, and weakness, my surgeon referred me to a pain management clinic and requested an MRI with and without contrast. The results of the MRI showed nothing to explain my symptoms and all of the x-ray's I've had appear to be normal...

After some discussion my doctor at the pain clinic stated he does not believe I am addicted nor that the narcotics are a problem, stating that he believes I truly need them for pain. He subsequently started me on MS Contin 15 mg's 2xdaily with 10/325 mg's hydrocodone/apap 2xdaily as needed for breakthrough. On my second appointment after deciding the MS Contin was wearing off too fast and not relieving the pain he prescribed 30 mg's MS Contin 3xdaily and continued the 10/325 mg's hydrocodone/apap 2xdaily as needed for breakthrough. At that same appointment he offered me the choice of staying on the strong narcotics Ms Contin/Hydrocodone or switch to Suboxone to see if that might offer relief. Personally I think while he honestly believes I do not have a problem, perhaps in the back of his mind he may have been testing me, seeing what I would choose. Not that I blame him, with the way things are nowadays I probably would have done the same.

Currently I am on my 2nd of 3 days of allowing the morphine to leave my system, switching strictly to short acting Norco's before I start the buprenorphine. After doing some research on the Suboxone however, I am concerned that it will be highly ineffective at relieving my pain, even though it has a mean half life of 37 hours. Due to the Naloxone, I also won't be able to take anything else in combination in order to increase pain relief in case it does not work as well as I am hoping.

I have tried to be as thorough as possible in order to save from re-posting to answer questions. However, if I have missed anything please let me know so that I can get as much information as possible. Also, if I am misinformed about anything please correct me. While I know I will not become addicted to these drugs, I also cannot live a normal life with this much pain. Which, unfortunately for now, means I must take medicine in order to have some resemblance of a normal life. As it stands right now, my pain is not manageable and the symptoms in my lower extremities are getting progressively worse...

At the risk of some accusing me of abusing my medication I will be honest and state that so far the best relief I have found is 30 mg's MS Contin 3xdaily along with 2 10/325 mg's hydrocodone/apap as needed for breakthrough pain which is on average 2 times daily, with bad days approximately 3 days a week. While some may argue that I am taking too much I can honestly state that I feel very little side effects and even family members have argued on my behalf because they know the drugs do not affect my life in a negative way. Unfortunately, I have to underplay my levels of pain to my doctors for fear of them thinking I am trying to get "drugs"...
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Comments

  • I take MS contin 30 mg x2/day and I don't feel high or anything. The long acting drugs are made so we don't get addicted because they are released slowly. I told my Doctor I was also taking percs occasionally for the break thru pain. I hope the pain management Dr. can help you. Are you using a cane to get around and take the pressure off your back? I don't know if this helped or not but hope you get some relief. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I must say that the amount of meds that you are/were on, seem normal. I know people in chronic pain on here, my personal friends and myself that have been on higher dosages than you. Whether it be higher dosages of other meds or the same meds.
    Now with the MS Contin, it didn't work that great for me at all! I was RX'ed 2-3 per day with Norco 10's or Percocet 10's 1-2 3-4x's a day. The Oxycontin 5mg worked for me but it seemed that I built up a tolerence to it so it stopped working as well and I told the doc no more because I didn't want to increase my dosage. So we stopped them. I am not currently on the MS Contin, Oxycontin or the Norco. I am on Percocet 10/325's at the moment, along with Nortryptine. We generally switch the Norco 10/325's and the Percocet 10/325's and vice versa every 2-3 months, due to the fact that they stop working as well and the doc said that I am building a tolerence. When we do switch I need less per day of the med that we are switching to then the one I was on. So at the end of 2-3 months lets say, for example, I was needing 6-8 Norco per day, when we switch to Percocet I just need 3-4 on the bad days. If at the end of the 2-3 months of the percocet I was taking 5-6 per day when we switch to norco I only need 3-4. My doc and I have come to the conclusion that the longer acting meds really didn't help that much. Which suck's because I would rather take 2 long acting with a couple short acting then just short acting. I think that there are some of us out there that the long acting meds just don't work as well as they should.

    Now as far as Suboxone, I have no experience with it. I know there are a couple threads in the pain med forum section. One of them has a link that takes you to a site that talks about Suboxone for getting off of meds. Check that out. In a different thread in the same forum, it talks about it being used for pain relief. I really don't know what to tell you about the Suboxone because like I said I have NO experience with it.

    Has your doc tried Lyrica or Neurontin with you yet? These are both nerve pain relievers. They take about a week to really get into your system and kick in. My doc also put me on Amitriptyline then switched me to nortryptiline at night for the nerve pain and to help me sleep. They are both anti-depressants but seem to help with the nerve pain. The Nortryptine seems to help more for me. I am sure there are other nerve pain relievers but I am not sure what they would be. These would be something to bring up to your doctor. I believe they are all non-narcotic also.

    Anyway DO NOT EVER under discribe your pain, ESPECIALLY to your doctor. Be fully honest with your doc. What I have suggested to many people and I do it myself, is to keep a pain journal. I write in it while I have my coffee in the AM and document how my nights sleep went and if I kept waking due to pain I would write down the times and the pain levels. Then I write in it at lunch time and document my pain levels for the AM up to that point and how well my meds are working and what meds and dosage I used to alleviate the pain. I then write in it after dinner and do the same documentation as I did at lunch. Then once again before bedtime. This way when I have my monthly appointments with my PM or when I see my NS I don't have to pull all of this stuff from my memory. This type of documentation especially helps when the doc is changing my meds! Be sure to write dates, times, med's, med dosages what time meds were taken and how they are helping if at all. The more info the better. I was a bookkeeper when I was working so I guess sometimes I get too detailed. But that is better I guess.
    Sorry this is so long but I hope it helps a little. I will find the forums and link them to this thread.
    Have a great day! MJ
  • Type up in the search field on the top right of this page Suboxone. There are actually quite a few different place where members have posted things on this medication.
  • Ah, I knew I was going to forget something... Yeah, I've been on Neurontin and Lyrica before. Neurontin doesn't do much except make me almost feel mildly drunk. The Lyrica makes me drowsy. Unfortunately, both of which don't have a productive effect on any of my symptoms. Thanks for the input.
  • Hi and welcome to Spine Health. Sorry you are having such a time of it so early on in life. Hey and thanks for serving in the USMC!!! Awesome stuff!!! Did you ever make it over to "The Rock"?

    Anyway, you didn't forget to mention Neurontin, it was in your original post so you are not losing your mind yet. Is your pain in your legs or in your back? I gather the tingling and numbness is in the legs and feet?

    How long have you been dealing with the pain management doc? Like MelissaJo said, never understate your pain. Especially when it comes to Pain Management. The key to effective treatment and a good relationship between you and the doc, is honesty.

    Hang in there,

    "C"
  • The pain is in both actually. The pain is constantly in my back at the injury site, always bad, or worse. As far as the legs go, yes the numbness, tingling, pain, and weakness are all intermittent... Which is to say mostly there 75% of the time with breaks in the symptoms that come and go. As far as a pain level goes, it's hard to put a number on it. Let's just say if it only wakes me up once during the night, that was a good night, even with sleeping pills. Days, on the other hand... Good days are bearable. Bad days suck the life right out, and could bring a person to their knees. This coming from someone who finished an obstacle course during which fractured two vertebrae and bulged a disc... And no, unfortunately I was injured before I was deployed to Iraq/Afghanistan.
  • haglandc said:

    Anyway, you didn't forget to mention Neurontin, it was in your original post so you are not losing your mind yet. Hang in there,

    "C"

    See I AM the one that is losing MY mind. Well maybe it is just short term memory loss at this time. LOL

    Have you tried the Nortryptiline or the Anitryptiline? Knowing my luck you have already mentioned this in your original post! LOL

    I had an L5-S1 fusion w/hardware in 2004. So I know how the good and bad days go. On good days my pain is a 4-5 on my bad days I am a 10 plus! My pain is usally a steady 6 or so though. My tingling in my right leg usually gets really bad when I am driving or sitting. Especially if I am sitting on the couch without a pillow under the back of my knee. We are trying to figure out why I get the leg pain, tingling and numbness now. I have had MRI's and my nerve roots look good according to my NS. BUT I have had an EMG and the doc that did that said I have severe nerve damage in my leg. So who knows. My hip, leg, knee and foot pain/tingling/numbness started before the surgery. It returned about 6 months or so after surgery but was tolerable and would come and go and I didn't need any meds. About a year ago all of the pain returned full force. The hip down to my foot is now steady, and my low back feels like it did before surgery. My SI joint is messed up and now they think either the harware is failing OR my L5-L4 area is screwed up. so once again more and more testing. :O
    Anyway I hope that you can find a med that will give you more relief. Keep us posted on your progress!
    And as "C" stated...THANK YOU MILLIONS FOR SERVING OUR COUNTRY!!! :))) It definately takes a very special person to do so! THANKS AGAIN!!

    Have a great day! and again keep us posted! (8)
    MJ
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